What is meant by the term "histrionic personality disorder"? How can a person get help for someone who doesn't want it but is exhibiting serious behavior?

C.L.

Histrionic personality disorder is a diagnosis in the current psychiatric diagnosis manual (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, otherwise known as DSM-4). People who fit the criteria for the condition exhibit "pervasive and excessive emotionality and attention-seeking behavior" that begins by early adulthood and is manifested in several different contexts or settings, causing problems in their lives. (This description and those below are from the DSM-4.)

Individuals who meet diagnostic criteria for histrionic personality disorder do not feel comfortable or appreciated unless they're the center of attention -- which they sometimes achieve by creating a scene or making up stories. They're often dramatic and charming (as well as inappropriately seductive), but these qualities soon wear thin upon those around them. Their emotions may seem shallow and rapidly change, and friends and acquaintances may become embarrassed by intense public displays of emotions. They frequently use physical appearance to draw attention to themselves and may spend an excessive amount of time, energy, and money on clothes and grooming. They are also thought to be highly suggestible, to be easily influenced by others, and subject to flights into romantic fantasy.

Individuals with histrionic personality disorder may unconsciously act out a role (such as "victim" or "princess"), and may control others through emotional manipulation or seductiveness and dependency. The condition is diagnosed more frequently in women and may be affected by sex role stereotypes.

Whether someone has histrionic personality disorder or any other condition, you can't force that person to get help unless she (or he) is in immediate danger of severely hurting herself or someone else. (In cases of imminent danger to self or others, the person can often be involuntarily hospitalized. Such actions should never be taken lightly, and can easily backfire, making the person even more reluctant to seek help or continue treatment.) What you CAN do, however, is become aware of ways in which you might be manipulated by the histrionic individual, and stop any responses that promote that. When such individuals report they are experiencing extreme distress over some matter, you can be briefly sympathetic and recommend counseling, but stop playing any role you might have assumed in their dramas ... which includes the role of "rescuer."

The dramatic aspects of histrionic personality disorder overlap somewhat with borderline personality disorder, although people with BPD also tend to be self-destructive and frequently angry, and to have chronic feelings of emptiness and identity disturbance.